Individual
MARY GILLIAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LSW
Contact information
Practice address
2860 NORTHPARK AVE, HUNTINGTON, IN 46750-9700
(260) 356-2875
(260) 358-0611
Mailing address
2621 E JEFFERSON ST, WARSAW, IN 46580-3880
(574) 267-7169
(574) 269-4189
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
33007778A
IN
Other
Enumeration date
07/08/2016
Last updated
07/08/2016
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